Pneumonia Flashcards
Define Pneumonia
An acute lower respiratory tract infection illness associated with fever, symptoms, signs in the chest and abnormalities on the CXR
What are the symptoms of pneumonia?
Systemic upset - Fever, rigors, vomiting Cough - Short, dry, painful, progressing to productive w/ mucopurulent sputum Dyspnoea Pleuritic pain Ederly pts acutely confused
What are the signs of pneumonia?
Tachypnoea
Decreased chest expansion, dull to percussion (affected area)
Coarse crackles, pleural rub w/ bronchial breathing (affected side)
Increased vocal resonance
Upper abdo tenderness (lower lobe pneumonia)
Describe the CURB65 score
Measure of pneumonic severity Confusion Urea >7mmol/L Resp rate >30 BP <90s OR <60d >65
What are the three CURB65 classifications of Pneumonia?
0-1 = Mild, home if possible, PO a/b 2 = Moderate, hospital admission, IV a/b 3 = Severe, poss ITU, IV a/b
What are the common pathogens causing CAP?
Conventional (60-80%) - Strep. pneumoniae, H. influenzae
Atypical (10-20%) - Mycoplasma, chylamydia, legionella
Virual (10-20%) - Influenza/parainfluenza
What are the common pathogens causing HAP?
G- enterobacteria S. aureus Pseudomonas Klebsiella Bacteroides Clostridia
What factors predispose patients to Pneumonia?
Smoking Asthma COPD Age Immunodeficiency Alcohol
Define lobar pneumonia
Pneumonia affecting a large and continuous area of the lobe of a lung due to bacteria gaining entry to distal air spaces
Pts normally adults, severely ill
What are the causative organisms of lobar pneumonia?
Strep. pneumoniae
H. influenzae
Moraxella catarrhalis
M. tuberculosis
What are the four histological stages of lobar pneumonia?
Congestion (<24hrs)
Red hepatization/consolidation
Grey hepatization
Resolution
Define Bronchopneumonia
Pneumonia where the primary infection centres around the bronchi, spreading to adjacent alveoli
What are the causative organisms of Bronchopneumonia?
Staph. aureus Strep. pneumoniae H. influenzae Proteus E. coli
What is the pathology behind Bronchopneumonia?
Initial consolidation patchy, can become confluent
Most common in infancy/old age
Most commonly affects lower lobes
How should Pneumonia be investigated?
CXR Bloods - FBCs, U&Es, CRP, LFTs Blood cultures Urine antigen (Legionella/pneumococcal) MC&C on sputum/aspirate Serum mycoplasma IgM Viral throat swab
What signs of Pneumonia are present on a CXR?
Lobar/multilobar infiltrates
Cavitation
Pleural effusion
What are the complications of Pneumonia?
Parapneumonic effusion/empyema
Post-infective bronchiectasis
Lung abscess (clubbing)
Sepsis
What antibiotic therapy is given in Pneumonia?
Mild - amox + doxy
Mod - amox + clarith + doxy
Severe - co-amox + clarith
What physiotherapy can be given in Pneumonia?
Admission avoidance Management of resp failure Management of airway secretions Reduce breathing work Manage co-morbidities Recovery from illness
What is HAP?
Hospital acquired pneumonia
Pneumonia developing <48hrs after admission w/ no signs of incubation on admission OR developing w/i 10 days of discharge
Describe a S. pneumoniae infection
Most common cause of CAP (if no COPD)
Vaccine, given to immunocompromised
Causes lobar pneumonia & ‘rust-coloured’ sputum
Describe a H. influenzae infection
Capsulated strain decreasing due to HiB vaccine
Non-capsulated common in COPD
Describe a M. pnuemoniae infection
Suspect in young pts (>40%)
Long hx of illness w/ extra-pulmonary features - rash, hepatitis, D&V, pericarditis, meningoencephalitis
Patchy consolidation on CXR
Treat w/ Erythromycin for 2/52
Describe a L. pneumoniae infection
Sporadic & outbreaks
Resides in air con units, common in smokers returning from holiday
Severe disease w/ hypernatremia & CN palsies
Proteinuria & haematuria
Treat w/ Erythromycin for 2/52
